Personalisation in Care Homes – what can be done?

Posted by Helen

Last November we launched a book with Dimensions called ‘Making it Personal for everyone – towards Individual Service Funds’. I handed a copy to the Department of Health’s Director General for Social Care, David Behan, when I saw him at a large conference last year. He asked me to describe what we had done, and then offered me a challenge:

“You have done it with six people living in residential care – come back to me when you have done it with 40 people.”

I took that challenge very seriously, and in partnership with Stockport Council and Borough Care, we are working to see how far we can go with personalising residential care for forty or more people living together.

Last week’s blog from Jaimee touched on person-centred practices with people living with dementia. This week, we want to share how we are trying to demonstrate this in a care home with forty-three people living with dementia.

We are trying to work at two levels:

1. That people living with dementia direct their own support on a day-to-day basis. We therefore need to know what matters to each person (what is important to them) and what good support looks like. We record this as a one-page profile.

2. That people have an upfront resource allocation that they can determine how to use. Each person will have two hours of individual one-to-one staff time each month that they can spend however they want, doing something that is important to them, where they want (in home or community) and choose who they want to support them.

We have started learning about this with Ellen who lives at Bruce Lodge and is 98. She has two sons, Stan and Roy who visit her. It is important to Ellen that she sits near the window or patio door where she can look out. She counts the planes which fly over and will tell you exactly how many have flown by. She loves watching the squirrels playing about in the garden. Ellen watches who is coming and going around the home and must always be supported to sit where she can keep an eye on what’s happening both inside and outdoors!

If you went to Bruce Lodge, you are also likely to hear Ellen singing. She is a wonderful singer and often sings Christmas carols in the Summer to raise a few smiles! She takes pride in her appearance and loves to have her hair tied up or plaited, with a bobble. A big Manchester United fan, Ellen also enjoys watching horse-racing.

Gill (From H S A who is supporting Borough Care) gathered this information with Ellen, and by talking to Stan, Roy and the staff who know Ellen. She also gathered detailed information about how to support Ellen well.

Here is what you would need to know if you were responsible for supporting Ellen:

• Ellen must be kept warm at all times.
• Always support Ellen to sit where she can look out of the window.
• Ellen loves birds – chat with her about the birds in the garden and when it is warm help her into the garden to feed the birds.
• Ellen must always be wrapped up well even if it feels warm outside – she is prone to chest infections & bouts of pneumonia.
• Know that Ellen will have lots of little naps during the day – she says there’s nothing wrong with that at 98!
• Know that Ellen will sometimes shout at you and say she wants to die. She will usually feel better after a cup of tea and a cream biscuit. Know that chatting to her about Stan and Roy or looking out at the birds and squirrels helps too.
• When Ellen is very vocal and upset, know that what works best for her is some time to herself.

Now our challenge is to make sure that all staff know this and act on it. When it came to ‘spending’ her two hours a month, Ellen said:

“I would love to go out to a cafe for a brew and a cake, or the park watching people, the dogs and the children playing. Then reading the war memorial on the tree in the park for the animals lost or who were a part of the war effort.”

Lisa, the manager at Bruce Lodge, is now looking with Ellen at which staff member she wants to support her, and how to make this happen on the rota.

Is personalisation in care homes possible? Can we offer more personalised support to people who live in residential care, or should we, as some have suggested, be putting all efforts instead go into closing congregate living like this? Please share your thoughts.



Ellen's one page profile



 

Treating people with dignity & respect means changing the way we think

Posted by Jaimee

Are we a society that cares about each other and values the contribution all people make, regardless of age and disability? On the back of the Panaroma episode last week Undercover: Elderly Care and Louis Theroux’s documentary Extreme Love, I witnessed and participated in several conversations about people’s values and a perceived lack of respect and appreciation for older people and disabled people and those that work for and with them.

While I can in no way suggest that these concerns are unjustified, and that something urgently must be done, I wanted to share a story that provides – to me at least – some reassurance that there are people out there who do care and who are working hard to provide care and support in way that treats people with dignity and respect.

Tricia is the manager of Vale House, a residential home in Oxfordshire that provides support to people who have profound mental health needs due to their dementia. She describes her work:

“It would be very easy for us to forget that our residents are individuals with their own personal history, background, things they like to do and things they are proud of. We’re helping to bathe and dress them, and have their meals in a day’s work. The easy way to do it would be just to treat everyone the same, to presume that all people over the age of 60 like to sit in a chair in front of a television for most of the day, or that they all like the same food. It would be very easy to get into the wrong way of doing it, but that wouldn’t be to use good person-centred practice.”

“If my mother was ill, I would want people to remember who she was, what her background is, and the things she used to like to do. Those things are very important to us here. Indeed, the whole process goes much more smoothly if we treat people as individuals. Every day and every moment in someone’s life is as important as the moment before. A moment in one of my residents’ lives is no less important than a moment in mine. I don’t throw away those moments and we shouldn’t do that for people with dementia. It really matters that we find out someone’s history and interests.”

Tricia and her team had helped a woman called Marjorie who, during an assessment in her previous care home, had sat quietly and not engaged in conversation. When talking with people who knew her, Tricia learned that Marjorie used to play the organ in her local church and that music had been an important part of her life. So when Marjorie came to live in Vale House, Tricia’s team decided to spend time with her for a short period each day to see if she could pick up tunes again. They would sing hymns and she started to pick them up and play them. Marjorie started to regain some dignity and went to concerts with a volunteer.

Person-centred practice, as a way of delivering personalisation in health and social care, does not necessarily need additional funding for it to make a massive difference to a person’s life (though I’m not suggesting that funding isn’t an important issue that needs addressing). But what I do want to make clear is that taking into account people’s whole lives, building their capacity and acknowledging the contributions they make, as individuals and as part of a community, can help solve some of the problems around ensuring all people are treated with dignity and respect. It requires - at the most basic and fundamental level - a different way of thinking. Thinking in a person-centred way helps us to understand and act on what matters to people, how they want to be supported, builds on their assets and enables them to become full members of their community.

As Louis Therox writes:

“However much is taken by dementia, something always remains. There can still be a person beyond their words and their memories, a spirit, for want of a better word, and a continuity with the person they were.”

Person-centred approaches help find this continuity and demonstrate that we do care and value all people, regardless of age or disability.